Multifactorial assessment and targeted intervention in nutritional status among the older adults: a randomized controlled trial: the Octabaix study

Abstract

BackgroundMalnutrition is frequent among older people and is associated with morbi-mortality.The aim of the study is to assess the effectiveness of a multifactorial and multidisciplinary intervention in the nutritional status among the elderly.MethodsRandomized, single-blind, parallel-group, clinical trial conducted from January 2009 to December 2010 in seven primary health care centers in Baix Llobregat (Barcelona). Of 696 referred people, born in 1924, 328 subjects were randomized to an intervention group or a control group. The intervention model used an algorithm and was multifaceted for both the patients and their primary care providers. The main outcome was improvement in nutritional status assessed by Mini Nutritional Assessment (MNA). Data analyses were done by intention-to-treat.ResultsTwo-year assessment was completed for 127 patients (77.4%) in the intervention group and 98 patients (59.7%) in the control group. In the adjusted linear mixed models for MNA, intervention showed no significant effect during all follow-up period with −0.21 (CI: − 0.96; 0.26). In subjects with nutritional risk (MNA ≤ 23.5 / 30) existed a tendency towards improvement in MNA score 1.13 (95% CI −0.48; 2.74) after 2 years.ConclusionA universal multifactorial assessment and target intervention over a two year period in subjects at nutritional risk showed a tendency to improve nutrition but not in the rest of community-dwelling studied subjects. Cognitive impairment was an independent factor strongly associated with a decline in nutritional status.Trial registrationThe clinical trial is registered as part of a US National Institutes of Health Clinical Trial: NCT01141166.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-015-0033-0) contains supplementary material, which is available to authorized users.

Effects of a Home-Based and Volunteer-Administered Physical Training, Nutritional, and Social Support Program on Malnutrition and Frailty in Older Persons: A Randomized Controlled Trial

“…Accordingly, our findings highlighted the positive intervention effect on nutritional and frailty status in older persons who were at risk of malnutrition. This is in line with another study, 56 where the results showed that it was possible to improve nutrition in participants at nutritional risk (31% of the persons), but not in the rest of the study participants. 56 However, these participants may still benefit from the physical training and nutritional intervention.…”

“…These improvements are comparable to the results obtained by health professionals. In a previously published study, the MNA score increased significantly following individual dietary counseling (without supplements) conducted by nutritionists, 55 but did not significantly increase following individualized nutritional support provided by medical specialists 56 in the intervention group, and the MNA score decreased in the control group (after 2 years). The authors of this study hypothesized that the general practitioners who conducted the intervention were not trained to address malnutrition intervention.…”

“…The authors of this study hypothesized that the general practitioners who conducted the intervention were not trained to address malnutrition intervention. 56 The continuous score of the SHARE-FI showed significant results, although the ordinal categories (robust, prefrail, and frail) did not (data not shown). The advantage of the SHARE-FI is that it provides a continuous score ranging from 0 to 5 with an associated categorical label.…”

“…Moreover, physical training and nutritional counseling/education alone or in combination (carried out by professionals) in older adults have been found to be effective in improving nutritional status 55,56 and in reducing frailty. 19,21,22,57 These findings support the view that malnutrition and frailty are reversible conditions and, as such, interventions or preventive programs could tackle these problems.…”

“…Thus, this made it difficult to distinguish which components of the intervention might be the most important elements in reducing impaired nutritional status and frailty. However, we chose a combined intervention because poor nutritional status and low physical activity have been identified among other pathophysiologic factors leading to frailty, 58 and combined interventions have been found to be able to prevent and tackle both malnutrition 55,56 and frailty. 59 In this regard, it is not essential to distinguish between nutritional and physical activity interventions.…”